Stage 5 of chronic kidney disease is also called the end stage renal disease where kidneys have lost almost 80 to 95% of its functional capacities. The glomerular filtration rate at this stage is 15 ml/min. It is characterized by appetite loss, nausea or vomiting, headaches, lack of concentration, itching, almost negligible urine, edema around eyes and ankles, muscular cramps, tingling sensation in hands or feet and increase in pigmentation of skin.
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Kidneys fail to excrete nitrogenous waste and fluids; cannot regulate blood pressure; are unable to produce RBC synthesizing enzyme and fail to synthesize the active form of vitamin D.
Treatment at this stage is done using dialysis or kidney transplantation.
- Hemodialysis removes waste and fluid accumulated in the blood. The blood is pumped into a dialysis machine wherein it is filtered and returned back to the system. Access into the blood stream is attained through a fistula, a graft or a catheter. It takes about 3 to 5 hours and needs to be done thrice a week.
- Peritoneal dialysis: This form of dialysis can be done at home, workplace or while sleeping as well. It needs to be done daily. A small catheter is placed in the abdomen through surgery and the abdominal lining acts as a natural filter. A cleansing solution is put into the abdomen through a catheter into which wastes and extra fluid from the blood is absorbed. This is then drained out.
- Transplantation: A healthy kidney is placed in the body of the patient through surgery. It does the work of two kidneys and dialysis is not required anymore. Post transplantation drugs are given to prevent rejection of the transplanted kidney.
Dietary changes that are done once dialysis begins include:
Avoiding whole grains, fruits and vegetables rich in phosphorus and potassium.
Diet is low in saturated fat and cholesterol.
Protein consumption is balanced with the loss during dialysis.
Special renal vitamins are given.
Daily consumption of phosphorus is limited to 1000mg, calcium to 2000 mg, vitamin C to 100 mg and potassium to 2000 mg.
Refined and processed foods and salt intake is completely cut down.
Adequate calorie consumption is must to maintain optimal weight and maintain healthy muscles.
Conservative kidney management:
Conservative care is sometimes used as an alternative treatment for end stage kidney disease. Dialysis is not done and only dietary management and medicines are used to treat the symptoms. In some patients where dialysis or transplantation would not bring about much improvement, conservative care is chosen to enhance their quality of life or life expectancy. This is usually done with people who are very old or are very weak.
Micro-Chinese Medicine Osmotherapy: It is a natural alternative treatment for kidney failure which is used externally. Processing of Chinese herbal medicines is done and then they are put into two bags which are kept under the lower back of patient. The herbal medicines are absorbed directly by the kidneys with the help of an osmosis device. It works by reversing kidney damage and patients can carry on without dialysis.
Immunotherapy: It is also an alternative to dialysis and involves blood purification and herbal medicines. There are six steps involved which combine eastern and western medicines.
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